WHO: 一个全球健康问题 - 宫颈癌

重要事实

• 人乳头瘤病毒是世界范围内一组极为常见的病毒。
• 人乳头瘤病毒有100多种类型，其中至少有14种可引起癌症（又称高风险类型）。
• 人乳头瘤病毒主要通过性接触传播，大多数人都会在性活动开始后不久感染人乳头瘤病毒。
• 宫颈癌由通过性行为感染的某些特定类型的人乳头瘤病毒引起。
• 两种类型的人乳头瘤病毒（16型和18型）引起70%的宫颈癌和宫颈癌前病变。
• 也有证据表明，人乳头瘤病毒与肛门癌、外阴癌、阴道癌、阴茎癌和口咽癌有关。
• 宫颈癌是生活在较不发达地区的妇女的第二常见癌症，估计2018年有57万例新发病例(1)（占全球新发病例的84%）。
• 2018年，约有31.1万名妇女死于宫颈癌，其中85%以上发生在低收入和中等收入国家。
• 宫颈癌综合控制包括一级预防（人乳头瘤病毒疫苗接种）、二级预防（筛查和治疗癌前病变）、三级预防（诊断和治疗浸润性宫颈癌）和姑息治疗。
• 世卫组织推荐使用对16型和18型人乳头瘤病毒有保护作用的疫苗，这些疫苗已在许多国家获准使用。
• 对30岁及以上女性的癌前病变进行筛查和治疗，是预防宫颈癌的一种符合成本效益的方法。
• 如果得到早期诊断，宫颈癌可以治愈。

何谓人乳头瘤病毒？

人乳头瘤病毒是最常见的生殖道病毒感染。大部分性活跃妇女和男性均会在人生某个阶段感染该病毒，有的还会反复感染。

女性和男性获得感染的高峰均为性活跃期开始后不久。人乳头瘤病毒通过性行为传播，但不一定需要插入式性交。生殖器皮肤接触被普遍认为是一种传播模式。

存在许多种人乳头瘤病毒，且很多并不会带来健康问题。通常情况下，人乳头瘤病毒在感染之后几个月内就会消失，而无需进行任何干预，约90%会在2年之内消退。少数几种特定类型的人乳头瘤病毒感染则会持续存在并发展到宫颈癌。

宫颈癌是迄今为止与人乳头瘤病毒有关的最为常见的疾病。几乎所有宫颈癌病例都是由人乳头瘤病毒感染导致。

某些类型的人乳头瘤病毒感染也可导致一定的肛门、外阴、阴道、阴茎和口咽癌。可以采用与宫颈癌类似的一级预防策略加以预防。

不会导致癌症的人乳头瘤病毒（特别是6型和11型）会引起生殖器疣和呼吸道乳头状瘤病（一种肿瘤在从鼻子和嘴到肺的空气通道中生长的疾病）。虽然这些病症很少导致死亡，但会造成大量发病。生殖器疣很常见，具有高度传染性，且会影响性生活。

人乳头瘤病毒如何导致宫颈癌

虽然大部分人乳头瘤病毒感染会自行消退，大部分癌前病变也会自行消失，但所有妇女都面临人乳头瘤病毒感染转为慢性的风险，以及癌前病变发展为浸润性宫颈癌的风险。

对于免疫系统正常的妇女，发展到宫颈癌需要15到20年时间。对于免疫系统薄弱的妇女，例如感染艾滋病毒但未得到治疗者，则只需要5至10年时间。

人乳头瘤病毒持续存在并发展到宫颈癌的危险因素

• 人乳头瘤病毒类型——其致癌性或致癌力；
• 免疫状态——艾滋病毒感染者等免疫功能低下的人员，更有可能持续感染人乳头瘤病毒并更快发展到癌症前期和癌症;
• 合并感染其他性传播病原体，如导致单纯疱疹、衣原体和淋病的病原体；
• 产次（出生婴儿数）和初生年龄； 
• 吸烟。

全球宫颈癌负担

宫颈癌是全世界妇女第四常见癌症。估计2018年有57万例新发病例，占所有癌症死亡妇女的7.5%。在每年逾31.1万宫颈癌死亡中，85%以上发生在欠发达地区。

在发达国家，已经建立相关规划，使得女孩能够获得人乳头瘤病毒疫苗接种，妇女可得到定期筛查。后者可使癌前病变在较易治疗的阶段被发现。早期治疗可使这些国家80%的宫颈癌得到预防。

在发展中国家，只能有限获得这些预防性措施。宫颈癌只有发展到晚期并出现症状之后才被发现。此外，要使这种晚期疾病得到治疗（如癌症手术、放疗和化疗）可能存在很大限制，因而这些国家的宫颈癌死亡率较高。

通过有效干预，就可在全球使宫颈癌的高死亡率（年龄标化率：2018年为6.9/10万）得到降低。

宫颈癌控制：一种综合方法

世卫组织建议采用一套综合方法来防控宫颈癌。建议的行动包括一整套涉及生命全程的干预措施。行动应该是多学科、跨领域的，包括社区教育、社会动员、疫苗接种、筛查、治疗和姑息治疗。

一级预	二级预防	三级预防
9-14岁女孩 人乳头瘤病毒疫苗接种	30岁以上妇女	有需要时所有妇女
女孩和男孩，视情况而定      与烟草使用有关的健康信息和警告   与年龄和文化相符合的性教育  推广安全套并向有性活动者提供安全套   男性包皮环切术	“筛查和治疗”： “一站式”方法    在卫生服务点针对高风险类型人乳头瘤病毒开展快速检  随即开始治疗   现场治疗	任何年龄人群的浸润性癌症治疗和姑息治疗   手术 放疗  化疗  姑息治疗

一级预防始于9-14岁女孩在有性生活之前接种人乳头瘤病毒疫苗。

建议男孩和女孩酌情采用的其他预防干预措施有：

• 安全性行为教育，包括延迟开始性活动
• 向已经有性活动者推广及提供安全套；
• 就烟草使用发出警告。烟草使用通常始于青春期，也是宫颈癌和其他癌症的重要危险因素；
• 男性包皮环切。

从30岁开始，应对处于性活跃期的妇女进行异常宫颈细胞和癌前病变筛查。

如果需要对癌症前期的情况作出处理，切除异常细胞或病变，建议采取冷冻疗法（通过冷冻来破坏宫颈上的异常组织）。

如果存在宫颈癌体征，治疗浸润性癌的选用方案包括手术、放疗和化疗。

接种人乳头瘤病毒疫苗

目前有三种疫苗可以提供针对人乳头瘤病毒16型和18型的保护，这两种类型的人乳头瘤病毒可引起至少70%的宫颈癌。第三种疫苗可以对另外三种类型的致癌性人乳头瘤病毒带来保护，这些类型会导致另外20％的宫颈癌。鉴于只对16型和18型人乳头瘤病毒带来保护的疫苗也可能对其它可引起宫颈癌的不常见人乳头瘤病毒类型提供一定的交叉保护，因此世卫组织认为三种疫苗对于宫颈癌具有同等保护作用。其中两种疫苗还可对引起肛门生殖器疣的6型和8型人乳头瘤病毒形成保护。

临床试验和上市后监测情况表明，人乳头瘤病毒疫苗非常安全，而且在预防人乳头瘤病毒感染方面非常有效。

人乳头瘤病毒疫苗如在接触到该病毒之前接种会效果最佳。因此，世卫组织建议对大都还没有开始性活动的9-14岁女孩实施疫苗接种。

疫苗不能治疗人乳头瘤病毒感染或宫颈癌等与人乳头瘤病毒有关的疾病。

一些国家已开始为男孩接种疫苗，理由是该疫苗可以预防男性和女性生殖器癌症，且有两种可用疫苗还可以预防男性和女性生殖器疣。由于疫苗接种是预防宫颈癌最为有效的公共卫生措施，因此世卫组织建议年龄在9-14岁的女孩接种疫苗。

接种人乳头瘤病毒疫苗不能代替宫颈癌筛查。在已经采用人乳头瘤病毒疫苗的国家，可能仍然需要建立或加强筛查规划。

癌前病变的筛查和治疗

宫颈癌筛查包括在没有症状且可能感觉十分健康的女性中检查癌前不正常现象和癌症。通过筛查发现的癌前病变，可能很容易施治，并可避免癌症的发生。通过筛查还可在早期发现癌症，这时开展治疗就有较高的治愈可能。

由于癌前病变发展到癌症需要很多年，建议自30岁起对每位女性进行筛查并在此后定期筛查（频次取决于所使用的筛查检测法）。对于携带艾滋病毒的性活跃女性而言，一旦她们了解到自身的艾滋病毒感染状况，就应及早进行筛查。

筛查必须与获得治疗和阳性筛查结果的管理机制建立起联系。没有适当管理的筛查不符合道德规范。

世界卫生组织目前推荐使用3种不同类型的筛查检测法：

• 人乳头瘤病毒检测，以发现高危类型的人乳头瘤病毒。 
• 用乙酸进行目视检查（VIA）。 
• 常规（Pap涂片）检查和液基细胞学（LBC）。

关于癌前病变的治疗，世卫组织建议使用冷冻疗法或高频电波刀（LEEP）。对于出现晚期病变的妇女，应进行转诊，以进一步开展调查并作出适当处理。

浸润性宫颈癌的管理

当妇女出现宫颈癌疑似症状时，必须将其转到适当机构作进一步评估、诊断和治疗。

宫颈癌的早期症状可能包括：

• 育龄妇女在月经间期出现不规则点滴出血或轻微出血；
• 绝经后点滴出血或出血； 
• 性交后出血；
• 阴道分泌物增多，有时带有恶臭。

随着宫颈癌的发展，可能出现更严重的症状，其中包括：

• 持续性背部、腿部和/或骨盆疼痛；
• 体重减轻、疲劳、食欲不振；
• 分泌物有恶臭和阴道不适；
• 单腿肿胀或双侧下肢肿胀。

视癌症殃及的器官状况，在疾病晚期可能出现其他严重症状。

要根据组织病理学检查来作出宫颈癌诊断。癌症的分期根据肿瘤大小以及疾病在骨盆和远位器官的扩散程度确定。治疗则取决于疾病分期，可选方案包括手术、放疗和化疗。姑息治疗也是癌症管理的一个重要内容，可以减轻因疾病引起的不必要疼痛和痛苦。

世卫组织的应对

世卫组织已制定如何通过接种疫苗、筛查和处置浸润性癌来防控宫颈癌的指导文件。世卫组织与各国和伙伴一道制定并实施全面规划。

2018年5月，世界卫生组织总干事发出了消除宫颈癌行动呼吁，要求与合作伙伴和国家携起手来，扩大以预防宫颈癌为目标的3种基本干预措施的获得性和覆盖面：即人乳头瘤病毒疫苗接种、筛查和治疗癌前病变，以及处理宫颈癌。

英文链接：

https://www.who.int/cancer/cervical-cancer

[白水之鱼]

回复 'fish_fish' 的评论 : 祝你好运。

[fish_fish]

前面已经有过判决了：见U.S. court pays $6 million to Gardasil victims By Peter Lind - - Wednesday, December 31, 2014
WASHINGTON, April 10, 2013 - Gardasil, the vaccine for HPV (human papillomavirus), may not be as safe as backers claim.

Judicial Watch announced it has received documents from the Department of Health and Human Services (HHS) revealing that its National Vaccine Injury Compensation Program (VICP) has awarded $5,877,710 dollars to 49 victims in claims made against the highly controversial HPV (human papillomavirus) vaccines. To date 200 claims have been filed with VICP, with barely half adjudicated.
“This new information from the government shows that the serious safety concerns about the use of Gardasil have been well-founded. Public health officials should stop pushing Gardasil on children.” said Judicial Watch President Tom Fitton.

现在是新的诉讼。Jennifer Robi，24岁的前运动员和学者，16岁接种HPV疫苗后被困在轮椅上，表现持续不受控制的神经/肌肉收缩（抽搐）和PTOS和许多其他症状的自身免疫疾病。

疫苗2006年开始使用，周期太短难以判定最终效果，尤其是宫颈癌发生率10-30年后明显下降才能令人信服。而且，在这期间还要继续观察有无严重不良反应。

[fish_fish]

回顾一下Thiomersal（含汞）的故事吧。1930年引入疫苗制作，50、60、70年代出现区域性汞中毒后引起公众注意，之后的研究发现重金属包括汞对人体尤其神经系统有害。FDA和CDC在1999年的声明中声称没有找到确切的Thiomersal对人体有害的证据。但是，由于很多注射疫苗后的自闭症等患者提出诉讼，2001年夏天Thiomersal从疫苗中去除。2006年的诉讼结果使几家大药厂激活关门。

请注意该周期有多少年。难道在其中反对的人就是偏锋吗？

[白水之鱼]

回复 'fish_fish' 的评论 : 感觉你有点走偏锋了，难道，FDA，WHO,都都无视这些结果？

[fish_fish]

纠正一下，NCI认为从HPV感染到肿瘤开始形成要10-30年（https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet）：
Researchers believe that it can take between 10 and 30 years from the time of an initial HPV infection until a tumor forms. However, even when severely abnormal cells are seen on the cervix (a condition called cervical intraepithelial neoplasia 3, or CIN3), these do not always lead to cancer. The percentage of CIN3 lesions that progress to invasive cervical cancer has been estimated to be 50% or less (20).

[fish_fish]

这里是诉讼案的资料（https://childrenshealthdefense.org/news/court-hears-gardasil-science-and-moves-forward/）：
In fact, the rate for girls during the clinical trials (85/100,000) was 37 times the death rate from cervical cancer! Birth defects among children conceived during the study period were 5x those of the control group and miscarriages were doubled over background rates. Reproductive problems among vaccinated girls were 10x background rates. Finally, Merck’s own data showed that administering the Gardasil vaccine to girls who had previous exposure to HPV actually raised their risk of developing precancerous lesions (or worse) by almost 45%.

[fish_fish]

回复 '白水之鱼' 的评论 :
全貌是，天花、麻疹和百白破是空气传染，传染性高，致病率和病死率高，一旦传染是公共安全问题。
关于宫颈癌，2015年美国宫颈癌发病率为7.9/100,000，仅有5% HPV感染进展为原位癌（一般感染大约30年后），由于pap smear筛查，其中的91%的原位癌在36个月内诊治，70%的CIN一期和54%的CIN二期在12个月内诊治。收益人群与不良反应之比与传染病疫苗不可同日而语。HPV绝大多数人自愈，有的人甚至不知道已经患过病毒感染。
此外，HPV亚型超过百种，疫苗只是选择最可能的九种（新的GARDASIL?9），不能百分之百cover来预防HPV感染。
并且，Merck本身的临床实验还发现，如果已经有过HPV感染，疫苗接种后患宫颈癌的风险比对照组增加45%。该发现很可怕，因为30%以上的孩子10岁前就接触过HPV病毒。
https://www.classaction.org/gardasil里面有26个留言触目惊心（具体我的文章有提及http://bbs.wenxuecity.com/health/822865.html），其中的例子：
1) UGH? 4 years ago My daughter was given Gardisil at age
12, all 3 doses. She was one of the lucky ones who didnt suffer the terrible
side effects but I will say, 5-6 years after her last dose, she had an abnormal
pap and ended up having a leap procedure due to cervical dysplasia, which the
shot was supposed to protect against. Thank God we caught it before it became
full fledged cancer.
2)Marilyn Petty? a year ago My granddaughter got the shots when she was 11 or 12. She just turned 22.
She went to the Health Clinic and they found two different spots on her
cervical told her not to worry they would see her back in a year. Well I got
worried and looked up information on HVP didn't like anything I read so we took
her to another doctor. He checked her his self and ran some test. Guess what he
found. She has cervical cancer and he says it can't wait that it is at a very
serious stage and needs to be removed. Problem she is on Medicaid and they
don't want to cover this, but they covered the shots that was told that she
needed to protect herself from HVP. So now I am fixing to start an up hill
battle with Medicaid in order to get her the medical treatment she needs. Any
one that can help me with this one would be wonderful. I am not ready to lose
her. I have already lost my son. She is way to young to let die because of
government red tape. Wish me luck. I am so sorry to hear about everyone elses
problems with these shots. If I knew all this before, I never would have gotten
her those shots. They told me it was really needed and there should be no
problems. Catch phase there should be no problems.
3)Missouri_girl? 4 years ago Is it too late to sue the makers
of this awful vaccine? I tested positive for HPV 3 months after the last (of 3)
shots and then it progressed to me having LEEP surgery after that to remove
pre-cancerous cells on my cervix. Ive also dealt with 5years of severe
constipation, went threw a colonoscopy, endoscopy and im only 24! I never had
insurance, had to save up and pay all these bills off!
这里的例子更为极端，20岁左右就得了宫颈癌（Cervical cancer tends to occur in midlife and is most frequently diagnosed in women between the ages of 35 and 44. It rarely develops in women younger than 20，来源于
Key Statistics for Cervical Cancer - American Cancer Society）。而且都是打过HPV疫苗之后。
综上所述，HPV疫苗与其他疫苗相比并不安全，接种要慎重。

[白水之鱼]

回复 'fish_fish' 的评论 :

你提供的资料真实性，我一点都不怀疑，但你可能忽略了全貌。128:387=33%，三分之一诉讼成功，比例还是蛮高的。但你知道谁在左右这类诉讼和舆论，多少钱到了律师的口袋里吗？根据VICP资料：
仅2011年，每例成功诉讼平均获得78万美元赔偿，但律师费和其它法律费用（包括不成功诉讼费）多达1亿1千3百万美元。

疫苗伤害现象肯定存在，受害者理应得到赔偿，这都不是问题，问题是如我前面所讲，任何药物，疫苗都不完美，犹如鱼与熊掌，不能因为个案的存在而放弃重要的东西，进而承担更严重的风险。更不要被相关的利益团体所左右并产生恐慌。

自人类第一个疫苗 - 牛痘苗诞生以来，各种担忧，事故和争论一直伴随，但今天人们公认疫苗是人类最伟大的发明之一。天花，肺结核，小儿麻痹，百白破，麻疹等致命性传染病，想当初何等猖獗，现在却难觅踪影，如果不是人们广泛接种疫苗，今天又会怎样？吐血而死（结核），满大街的瘸子拐子（小儿麻痹），满脸麻子（天花）。。。HPV也是如此，不能因噎废食吧。我们的看法不一，可能因为我与你看问题的角度和高度不同。

[fish_fish]

https://www.nvic.org/vaccines-and-diseases/hpv/vaccine-injury.aspx
这个网站比较客观，有具体数字。
Even though the National Childhood Vaccine Injury Act of 1986 legally required pediatricians and other vaccine providers to report serious health problems following vaccination to the federal vaccine adverse event reporting system (VAERS), many doctors and other health care providers giving vaccines to children and adults fail to report vaccine-related health problem to VAERS. The evidence suggests that only one to 10 percent of serious health problems that occur after use of prescription drugs or vaccines in the U.S. are ever reported to federal health officials who are responsible for regulating the safety of drugs and vaccines and issue national vaccine policy recommendations.

As of July 1, 2018, 387 claims have been filed to the federal Vaccine Injury Compensation Program (VICP) for 14 deaths and 373 injuries that occurred after HPV vaccination. To date, the U.S. Court of Claims has compensated 128 of the 387 children and adults who filed claims for HPV vaccine injuries.

[fish_fish]

我当然相信了，大家可以去查已经发表的病例。HPV疫苗发生严重不良反应明显多于其他疫苗。
黑社会当然不是，因为只是宣传让大家打疫苗，没有强迫每个人必需去打。
利益驱动，任何政府部门都需要资金。美国已经还好了，没有象某些国家唯金钱至上，生成假疫苗或问题疫苗。

[白水之鱼]

回复 'fish_fish' 的评论 : 你描述的情况，感觉美国比黑社会还黑暗，人人好像是待宰的羔羊，你真的相信吗？

[fish_fish]

我在健康养生中开了个帖子，关于HPV疫苗　http://bbs.wenxuecity.com/health/822865.html
诉讼律师的结案陈词提到：Kennedy closed his powerful presentation by chronicling the parade of corrupt conflicts that caused HHS officials to turn a blind eye to the rife fraud that characterized the clinical trials. Merck loaded the two FDA and CDC panels that approved Gardasil, with paid toadies. He showed that the pharmaceutical industry actually pays 45% of FDA’s annual budget and that NIH and its officials own part of the patents to the Gardasil vaccine and collect royalties on every vaccine sold. NIH collects tens of millions of dollars annually from Gardasil sales. Finally, 45% of CDC’s budget goes to promoting and purchasing vaccines. Merck exerts control over the CDC with millions of dollars in contributions to the CDC foundation, which allows funding for pet projects. This level of support gives Merck the power to also punish the CDC by withholding funding if displeased by the agency.
鉴于FDA和CDC与药厂有COI，有共同的经济利益，我并不能完全相信他们的报告。

这里有有关Gardasil 副作用的病例报告和研究：https://medscienceresearch.com/gardasil/ 强烈推荐该网站，有链接可以查到相关的发表文章。

[白水之鱼]

如果大家对疫苗的安全有问题，建议去美国疾病控制中心的相关网站看看，链接：
https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html

HPV Vaccine Side Effects
The HPV vaccine is very safe, and it is effective at preventing HPV. Vaccines, like any medicine, can have side effects. Many people who get the HPV vaccine have no side effects at all. Some people report having very mild side effects, like a sore arm from the shot. The most common side effects are usually mild.

Common Side Effects of HPV Vaccine:
Pain, redness, or swelling in the arm where the shot was given
Fever
Headache or feeling tired
Nausea
Muscle or joint pain

我觉得大家应该对美国的药品（包括疫苗）的审批和监管系统有信心。还不放心，问一问周围打过疫苗的人，到底有没有副作用，有什么副作用，作用大不大？

[白水之鱼]

回复 'luck86' 的评论 : 如果孩子还小，不妨多观察几年。医生，学校推动接种这种疫苗，说明了疫苗的意义，难道医生，学校老师没有孩子？他们的孩子不打疫苗，专门忽悠别人打？

[白水之鱼]

回复 'bjszh' 的评论 : 你的理解和比喻挺有道理。就像药物一样，没有完美的东西，为了治病和防病，必须承担一定风险。

[luck86]

很不理解为什么医生和学校要advocate 9_14的女孩take这个shot, 这个年龄的女孩生理还没发育成熟，有的period 都还不规律，打了shot,如果有副作用，更难分辨到底是什么引起的。

[bjszh]

看来不接受小于号。
只要B远远小于A，综合社会效益就是好的。你是愿意冒10%还是1%的风险？

[luck86]

其他儿童期的疫苗，我都支持，毕竟已经存在了很长时间，相对安全。而这个HPV的contradiction好像比较大，而医生和媒体又大力推崇，其实让人迷惑。谢谢fish_fish 提供的新的信息，也感谢楼主提供这个讨论的平台。毕竟有时即使risk不大，但如果确实存在，而且发生了，那就是100%的risk了，

[bjszh]

不知为什么砍去了结尾。
只要 B

[luck86]

而且好像这个疫苗有效保护期只有10年，那么如果小孩在14岁接种这疫苗， 到24岁就失效了，而有的保守点的女孩说不定到那时还没机会会 expose HPV病毒，那么take这个疫苗比较大的副作用的风险就没有意义了。不知我认为的10年保护期准不准确，希望更了解这疫苗的网友指正。

[luck86]

谢谢fish_fish提供的信息，也很关注这个问题，主要是媒体，学校非常promote这个疫苗。我暂时选择了不给小孩打这个疫苗， 因为她还太小。但小孩回来问我为什么不给她打，不打会得cancer，她们同学都打。希望能多点信息供人们做出相对好的选择。

[bjszh]

谢谢这里严肃的讨论。我不是学医的，讲点外行话。无论哪种疫苗，如果假设不打的发病率为10%(A)，而打了有严重副作用的为1%(B)，那么对这1%的人来说，本来好好的，打疫苗打出了毛病，当然会反对。但对那些因为疫苗而避免染病的10%来说，结论就不一样了，只要 B

[fish_fish]

这里是庭审律师的描述：
2.3 % of the girls receiving the vaccine complained of symptoms of autoimmune disease within 7 months. Since cervical cancer kills only 1.5 Americans in every 100,000, he noted, “Merck’s own data show that the chances of getting an autoimmune disease from this vaccine are 1000 times the risk of dying from cervical cancer.”
Not only did a heartbreaking 50% of the subjects in both the study group and the spiked placebo group experience a serious adverse event within the seven months of the trial, death rates among girls in the study were double background rates. In fact, the rate for girls during the clinical trials (85/100,000) was 37 times the death rate from cervical cancer!

[fish_fish]

从 FDA’s Vaccine Adverse Event Reporting System (VAERS)报告来看，HPV的副作用不可谓不高。仅有5%的HPV感染与宫颈癌相关，smear早期筛查能显著提高早期诊断和生存率。因此，要慎重考虑是否接种HPV疫苗。
https://childrenshealthdefense.org/news/court-hears-gardasil-science-and-moves-forward/ 这里是有关2019年1月庭审记录，披露由于免疫周期要长，因此默克公司用了更大剂量的AAHA无定形磷酸氢铝佐剂，而他们的安慰剂对照组没有用公认的惰性安慰剂，而是用同样大剂量的AAHA，因此，掩盖了疫苗产生的副作用（来源于大量佐剂导致的自身免疫损害）。该大剂量的AAHA在动物中能导致自身免疫反应。
此外，默克公司临床实验的人群选择与临床应用不符，从来没有低于15岁年龄组的临床研究。

[fish_fish]

HPV Vaccine VAERS Reports

Description 12/14/2018 TOTAL
Disabled 2,856
Deaths 458
Did Not Recover 12,199
Abnormal Pap Smear 667
Cervical Dysplasia 324
Cervical Cancer 148
Life-threatening 962
Emergency Room 15,401
Hospitalized 6,047
Extended Hosp. Stay 291
Serious 8,873
Total Adverse Events 60,714

The cervical cancer diagnosis rate in the United States is 7.9/100,000. Given that only 5% of HPV infections progress to neoplasia (CIN) and that 91% of early stage cases resolve spontaneously within 36 months, with 70% of CIN 1 and 54% of CIN 2 cases doing the same within 12 months, using these pathologies as surrogate markers for cancer incidence represents a scientific shortcoming.

文学城上有关HPV副作用的帖子：
关于HPV疫苗 来源: 咪呜 http://bbs.wenxuecity.com/health/294973.html
绝对要看：HPV子宫颈癌疫苗首席研发员说出的真相 医者意也 http://www.wenxuecity.com/blog/201603/41693/737545.html
最新研究：美国默克公司HPV疫苗关联美国25-29岁年龄组妇女生育率下降 ——来来来，讨论一下这个问题
薛成 https://bbs.wenxuecity.com/health/797772.html

[白水之鱼]

回复 'fish_fish' 的评论 : 欢迎这种理性讨论。我不是说要忽略这些副作用，但我认为它们属于极端个案。打疫苗的副作用风险高不高？最直接可信的办法是问一下周围人群，有没有发生过或听过类似的案例。

研究发现，近一半的美国男性感染了致癌性人乳头瘤病毒（HPV），但与女性不同的是，男性可能一生都处于带毒感染状态。

HPV是美国最常见的性传播疾病。大约7900万美国人感染了不同类型的HPV，约一半的新感染病例发生在24岁之前。

HPV属于一种恶性感染。每年有超过9,000例与HPV相关的癌症发生在男性身上。HPV是导致63％的阴茎癌，91％的肛门癌和72％口腔和咽喉癌的原因。

此外，男性中的HPV是引起女性宫颈癌的间接原因。该病毒也是导致90％的生殖器疣的原因。 HPV还可导致呼吸道的肿瘤，称为呼吸道乳头状瘤。

美国著名影星道格拉斯自己患的喉癌就是由HPV引起的，他多次在媒体上宣传HPV，希望引起社会对HPV的关注，同时呼吁美国的年青人注射HPV疫苗。

虽然自2009年以来已经有HPV的疫苗，但覆盖率仍然很低。只有约11％的男性和33％的女性接种了这种疫苗。

根据美国CDC调查，大多数感染HPV的人不知道他们已经感染，因为感染者通常不会出现明显的症状。


详情请参考链接：http://blog.wenxuecity.com/myblog/70732/201701/24234.html

[fish_fish]

现在多个国家，包括法国、日本、印度和美国都有针对Gardasil的诉讼，希望早日得出结论。
下面是一则以前的新闻：
U.S. court pays $6 million to Gardasil victims By Peter Lind - - Wednesday, December 31, 2014
WASHINGTON, April 10, 2013 - Gardasil, the vaccine for HPV (human papillomavirus), may not be as safe as backers claim.

Judicial Watch announced it has received documents from the Department of Health and Human Services (HHS) revealing that its National Vaccine Injury Compensation Program (VICP) has awarded $5,877,710 dollars to 49 victims in claims made against the highly controversial HPV (human papillomavirus) vaccines. To date 200 claims have been filed with VICP, with barely half adjudicated.
“This new information from the government shows that the serious safety concerns about the use of Gardasil have been well-founded. Public health officials should stop pushing Gardasil on children.” said Judicial Watch President Tom Fitton.



The CDC recommends the Gardasil vaccine, made by Merck Pharmaceuticals, for all females between 9 and 26 years to protect against HPV. Furthermore, the CDC says Gardasil is licensed, safe, and effective for males ages 9 through 26 years.

The facts appear to contradict the FDA’s safety statements. The adverse reaction reports detail 26 new deaths reported between September 1, 2010 and September 15, 2011 as well as incidents of seizures, paralysis, blindness, pancreatitis, speech problems, short term memory loss and Guillain-Barré Syndrome. The documents come from the FDA’s Vaccine Adverse Event Reporting System (VAERS) which is used by the FDA to monitor the safety of vaccines.

That’s 26 reported deaths of young, previously healthy, girls after Gardasil vaccination in just one year.

[fish_fish]

5)Sondra Sierko January 17, 2019 at 7:57 AM
My daughter has had a continuing period for over a year since getting this vaccine. I felt guilted into getting it for her at age 15 and am angry that I went against my better judgment and complied. She is miserable and more depressed. When I went back to the dr they refused to believe it had anything to do with the HPV vaccine and that it was pure coincidence that it happened at that time. No show of concern or compassion, they couldn’t understand why I was so upset, then they offered to put her on birth control! What?!
抱歉在您的博客上发表这么多信息，只是希望大家更好的权衡利弊，做出对自己和孩子最好的决定。
谢谢您的文章！

[fish_fish]

其他疫苗副作用没有这么大，有的认为与自闭症相关。
HPV疫苗的副作用很多认为与自身免疫有关，有的很严重。因为HPV不像天花、麻疹等空气传播、病死率高，因此是否接种要衡量其利弊。我的孩子其他疫苗都接种了，但我觉得我可能会拒绝HPV。

下面是“The New Gardasil: Is It Right For Your Daughter?”一文中的评论：
1)Dee August 2, 2016 at 2:49 PM
My Son was diagnosed with POTS after receiving the Gardasil vaccine…he developed symptoms the day after his second shot! We were lucky. It only took us about six weeks to get get into the Mayo Clinic where we did, at the final hour, get a POTS diagnosis. It is almost one year later and he still struggles with symptoms each day. We were told that he should be able to manage his symptoms by simply drinking a Gatorade or two each day and exercising daily. He is 19 and had to defer enrolling in college for a semester due to his condition. He was able to attend college during the second semester and will return this fall. Brain fog, fatigue, dizziness, and stomach issues are his main complaints and we are just now beginning treatment with a POTS specialist. I’m so angry with myself for being sucked into the hype and allowing my son to get this vaccine. He says he has forgotten what it is like to feel good because he feels lousy all the time.
2) cathy friedman May 6, 2018 at 10:37 AM
My daughter fainted four days after receiving the guardasil 9 shot. She had to withdraw from graduate school and has recently been diagnosed with POTs by Dr. Brent Goodman at the Mayo Clinic in Scottsdale.
I would love to talk to you about what happened to our daughters. There are so many out there who have been injured. We need to do something. There must be a way to file a class action law suit against Merck. They know something and I am determined to hold them accountable. This has been a nightmare. Please email me at [e-mail]. Thanks!
3) Machae July 26, 2017 at 11:25 PM
Hi, I want to thank ypu for giving the real facts behimd the terrible shot. I am almost certain I aquired POTS with RAS(seizures) through the shot. I wish people would listen.
4) Emily March 11, 2018 at 8:36 PM
Thank you for affirming what I know now about this vaccine. I made the mistake of having my daughter have this vaccine although it was never presented to me as an option. Ever since, the pain and depression and change in personality has haunted us. I tell every parent I know to make sure they speak out and not allow their child to have this vaccine. I wish daily I could turn back time and wonder what my, now teen’s, life would be like. I wish there was an antedote but every doctor here looks at me like I’m crazy when I mention it. Thanks again.

[白水之鱼]

回复 'Dlu2442' 的评论 : 世上有几人不接触？

[Dlu2442]

疫苗的副作用不可不注意。这个要有直接接触才会感染，因此觉得无需冒副作用的风险

[白水之鱼]

回复 'fish_fish' 的评论 : 任何疫苗都有副作用，随意Google任一疫苗，都会发现很多负面个案，但比起不打疫苗可能出现的风险小之又小，个人应该有个基本判断。

[fish_fish]

因为我的小孩再过5、6年就要考虑打疫苗的问题了，所以特地查了一些这方面的内容，只是想让大家知道一下这些信息。
我是学医出身，现在做研究。基于我查到的资料，打HPV疫苗要慎重考虑。

[fish_fish]

我查了一下，副作用可能不是几个极端例子，有兴趣的人可以读：
1)The New Gardasil: Is It Right For Your Daughter?　by Kelly Brogan, MD
这里的读者留言就有好几个例子。其中之一：cathy friedman　May 6, 2018 at 10:37 AM
My daughter fainted four days after receiving the guardasil 9 shot. She had to withdraw from graduate school and has recently been diagnosed with POTs by Dr. Brent Goodman at the Mayo Clinic in Scottsdale. I would love to talk to you about what happened to our daughters. There are so many out there who have been injured. We need to do something. There must be a way to file a class action law suit against Merck. They know something and I am determined to hold them accountable. This has been a nightmare. Please email me at [e-mail]　 Thanks!
2)还有sanevax.org网站，上面有一些例子。

[白水之鱼]

回复 'fish_fish' 的评论 : 疫苗的效果很好，新闻报道都是极端的例子。部分西方人反对注射疫苗，其实害人害己。最近华盛顿州麻疹流行，是很好的例子，因为全世界普种麻疹疫苗多年，麻疹在全球几乎灭绝，但因为小部分人不以为然，决绝接种，结果疾病卷土重来。

[fish_fish]

我以前是觉得接种疫苗是应该的，但最近有些新闻，使我不确定疫苗的副作用：
1) Court Hears Merck Gardasil Science and Moves Forward: google搜索即可
2) Addressing expected challenges after resumption of HPV vaccination：In Japan, an HPV vaccination program started in 2010, and the HPV vaccine became a nationally recommended routine immunization for girls aged 12–16 years in April 2013. However, because cases of young girls with widespread pain and movement disorders after vaccination were reported in the media in June 2013, Japan's Ministry of Health, Labour and Welfare (MHLW) announced the suspension of its recommendation for routine HPV immunization.